You are probably reading this because you are overweight or obese – that is the concern. I believe from literature and experience that being overweight is a significant contributing factor to your problem, symptoms and treatment options. Please don’t take offense to this advice. It is an opinion given because I believe you, and only you, can make a change that will be of benefit to you in the short and long-term.

Surgery may have a role to play in your care but you have the bigger part to contribute. If you are really ready to manage your weight issue the following may help you. It is not a prescription. It is a list of thoughts and ideas that may have some relevance and practical answers for you. What are YOU going to do?

Take in fewer calories and exercise more – that is the simple equation.

90% of the problem is what you eat and 10% is about doing more exercise.

Food

Have your calories at the beginning of each day – then you can burn them off.

Have a good breakfast, lighter lunch, and very light dinner.

NO AFTER DARK CALORIES

Two large glasses of water 30 minutes before each meal will distend the stomach and make you less hungry when it comes to the actual meal time.

Chew each mouthful – take your time to eat.

Next time you’re hungry, have a large glass of water. A lot of times when you are thirsty, the brain registers that as hunger.

Give up the alcohol. Two glasses of wine or two stubbies of beer have roughly the same number of calories as a ‘Big Mac’.

FOOD IS FUEL – Nothing more. How much do you REALLY need to get to the next fuel stop?

Exercise

Take some Paracetamol regularly – a modern convenience to make the pain easier.

A walking stick or hiking pole will take a lot of load off a painful leg.

Light arm weights can take the role of leg activity – you just need to do more.

Polish the joint – don’t punish it.

Exercise bike – move the seat around to find the right height.

Swimming pool, hydrotherapy.

Air Walker- exercise machine that allows the body and legs to swing without any impact.

Attitude

Aim for small goals. Check your weight regularly at the same time of day – but not every day.

Find someone to support you and preferably train with and ‘compete’ against. It is going to be hard work.

You feel hungry – that’s okay. Remember the water.

Why Take Notice of What I Say?

I believe that there is a significant increase in risks associated with surgery as your weight increases, and particularly that of infection. No matter what your scenario is at present, the complications of infection in Orthopaedic Surgery makes your situation a greater disaster than whatever you are confronting at this point in time. This is only compounded in the diabetic patient where the risk of infection is magnified once again. As your body weight goes up, the complications become more common and severe. The recovery is generally slower.

Being overweight is not simple. There are problems of self-respect, motivation, attitude and support.

Losing weight is not about the next diet. Losing weight and keeping it off requires a change in motivation, lifestyle and attitude. You will need support from family, friends and the medical profession – it is there but you might need to just ask for that support.

I believe that some of these suggestions can help you to help yourself. You have the potential. However, YOU are the one that has to do it.

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Ten Reasons You are Not Losing Weight on a Low Carb Diet

From the Poliquin Group

This is a fabulous review article. Don’t buy into the supplements stuff but do pay attention to the higher salt intake that is probably needed the lower you go with your carb decrease.

I know that I have preferred salted nuts whilst I have been on this journey. Steve Phinney made the same recommendations last weekend. Broth will do the same thing.

“Every woman knows that carbohydrate is fattening: this is a piece of common knowledge, which few nutritionists would dispute.” —Passmore & Swindells, two British dietitians writing in the British Journal of Nutrition in 1963

Whether you agree with the above quote or think it’s hilarious nonsense, there’s no doubt that reduced carb diets are useful for losing body fat.
A lot of people find that cutting carbs in favor of a higher protein, higher fat diet is the simplest way to get lean fast. However, people often make mistakes when going low-carb, especially if they are training hard in an effort to accelerate the fat loss process.With these 10 simple tips, you can make going low-carb a lot easier and get better fat loss results.

Mistake #1: Not Restricting Carbohydrates Enough
Low-carb, high-protein diets are effective for fat loss. This is a scientific fact. But, low-carb is a vague term.

Simply cutting the average American man’s carb intake of 310 grams a day in half could be considered low-carb, but if you are overweight and your goal is fat loss, you most likely need to go a lot lower than 155 grams.

A review in the American Journal of Clinical Nutrition suggests the 50 to 150 g/day range is too high for losing body fat in overweight, sedentary populations. A useful definition of a low-carb fat loss diet is less than 50 grams of carbs a day, which will lead to the production of ketones.

When the body is producing ketones it is no longer relying on glucose (sugar from carbs) for its fuel source, which is a state that provides significant metabolic benefits and easier fat loss.

Fix It: For best results, get those 50 grams of carbs from vegetables and select fruits, such as berries, pomegranate, or kiwi. Eliminate all grains—whole and processed.

Mistake #2: You are Lean, Active & Restricting Carbs Too Much
The AJCN definition of a low-carb diet as less than 50 grams a day was for sedentary, overweight folks—a population that is likely to have a degree of insulin resistance, inflammation, and a poor metabolism.

Lean, active people who are lifting weights and working out regularly tend to benefit from a higher carb intake, or from cycling carbs in order to replenish muscle glycogen. Carb cycling is also beneficial to improve the brain’s sensitivity to the metabolic hormones, insulin and leptin.

Additional reasons not to go super low in carbs indefinitely include the following:

Reduced thyroid hormone, which lowers body temperature and the amount of calories burned at rest. In lean people this typically leads to fat gain, whereas in overweight folks it leads to blunted fat loss.

Elevated cortisol. Carbs are useful for keeping the stress hormone cortisol in balance by providing an easy energy source for the body. When carb intake is very low, cortisol is released in order to free stored energy and provide glucose to keep you going. Having elevated cortisol all the time causes inflammation, adrenal fatigue, and eventually metabolic problems.

Fix It: If you’re active, pretty lean, and trying to lose fat on a very low-carb diet, try one of the following:

A common scenario is that someone starts a low-carb diet but doesn’t eat enough fat, feels terrible, and quits. Calories may be too low, or the ratio between fat, protein, and carbs may be off.

One thing that needs to happen when you go low-carb is your body must adapt to be able to burn fat instead of glucose. If you don’t adequately increase the fat you eat, energy production will be sluggish and you won’t be able to sustain your new way of eating.

Fix It: Chances are you need at least 50 percent of your calories to come from fat to make a low-carb diet work. The actual percentage will obviously vary based on carb and protein intake, but you absolutely want to make fat intake a priority.

Do this by eating fat at every meal, opting for fats from the following delicious sources: Omega-3s from fish and organic meats, medium chain triglycerides from coconut and red palm oil, and monounsaturated fats from olives, olive oil, nuts, and avocados.Mistake #4: Not Eating Enough Vegetables & Fruit

Many people think that a low-carb diet means they don’t have to eat vegetables since vegetables are carbohydrates. Although some people may be eating a low-carb diet and eliminating plant foods, this is generally not the best choice for a few reasons:

• Plants are some of the most nutrient-packed foods on the planet and they go a long way towards reducing inflammation in the body and preventing disease.

• Veggies and fruit provide indigestible fiber, which has been found to make people less hungry so they eat less. Plus, fiber is often lacking on low-carb diets since most people eliminate grains, which are a principal source of fiber in the American diet.

• Lower carb vegetables are a “free for all food” and you can eat as much of them as you want, which is helpful in reducing hunger and filling up your stomach.

This may not be so exciting if you don’t like vegetables, but here’s a hint—figure out a way to enjoy them, whether by trying new ones you’ve never eaten, cooking them with delicious spices and fats, or re-training your taste buds. Eating a lot of veggies is a must if you want success on a low-carb eating plan.

Fruit intake should be more individualized. If you are going for a ketogenic diet you will need to seriously limit fruit intake, but you may be able to get away with eating some berries or other lower glycemic fruits since they are still fairly low in carbs, but high in phytonutrients and fiber.

Mistake #5: Eating High-Glycemic Carbs at the Wrong Times

You can pretty much eat low-glycemic vegetables and maybe even berries any time you want, but higher glycemic carbs and refined carbs need to be eaten at specific times in order to avoid blood sugar spikes and reduce the body’s tendency to store them as fat.

Fix It: If you choose to eat “cheat” meals, post-workout is the best time to do so because you will have depleted muscle glycogen stores (the form of carbs that are stored in your muscles to fuel exercise) during training and your body will be primed to replenish those stores with any carbs you eat post-workout.

This does not mean that carbs are necessary, (muscle glycogen is only depleted by about 40 percent from high-volume training) but it’s the best time to eat ’em if you’re going to. The one exception is if are a serious athlete training multiple times a day or perform long-distance endurance training, in which case carbs are important post-workout.

Always avoid higher glycemic carbs pre-workout including most fruit because they will make the body favor carb burning over the use of fat, which is an inferior state for fat loss.

Also, always avoid high-glycemic, “cheat” foods in the morning or when you are under stress because this has been found to trigger greater food intake over the course of the day.

Mistake #6: Eating too much protein and too little fat.

It goes without saying that a lower carbohydrate diet needs to be higher in protein as well as fat.

But, how much protein do you really need? And are there any dangers to just eating as much protein as you can fit down your gullet?

First, if you are restricting carbs but eat more protein than the body needs, some of the amino acids in the protein will be turned into glucose via a process called gluconeogenesis. This provides an energy source that may reduce the body’s ability to burn fat, inhibiting fat loss.

A second thing that happens with a very high-protein intake is that the body is not able to efficiently eliminate the byproducts of protein metabolism such as ammonia, which is toxic for the body. This typically occurs at a protein intake around 230 to 250 grams of protein a day.

Third, when protein is not fully digested and it reaches the intestines, the gut bacteria “eat” it via a fermentation process. This causes you to have fewer beneficial gut flora and leads to the production of inflammatory compounds.

Fix It: For many people who work out, the 1.5 to 1.8 g/kg of bodyweight range of protein is ideal on a low-carb diet. Naturally, some people will benefit from eating a bit more, or from cycling protein so that they have a higher intake in the 2 g/kg range during hypertrophy phases.

#7: Combining Fasting and Low-Carb Eating

Many experienced reduced-carbohydrate eaters report excellent results from fasting. Both practices have similar benefits so it is reasonable to believe they can compliment each other well:

• They improve metabolic flexibility and the body’s ability to use both fat and carbs for energy.
• They improve cellular health and reduce inflammation.
• The improve balance of metabolic hormones that are deranged, such as reducing insulin resistance.

But both practices are stressful on the body and if you take them too far, which can easily happen when striving for leanness, you can experience hormone imbalances, poor sleep, and altered circadian rhythm.

Women appear to be especially susceptible to problems from pairing fasting with low-carb eating because hormone balance is more delicate.

For instance, if cortisol is chronically elevated in response to lack of glucose and calories, the body turns the hormone pregnenolone, which is a precursor to estrogen and testosterone, into progesterone.

Progesterone is then used to make cortisol and aldosterone. Together these hormones lead to greater fat storage and more fluid retention and mean the body is not working properly anymore.

Fix It: You can always try fasting down the road but most people who are new to the reduced-carb lifestyle will find the transition easiest by eating fairly frequent meals (5 to 6 a day) and focusing on ideal food choices. This will improve balance of the hormones that make you hungry and allow you to develop confidence in your eating habits.

#8: Confusion or Fear Due To the Ridiculous Things Your Friends Say about The Low-Carb Lifestyle
There are many misconceptions and lies floating around regarding reduced-carb eating. These are often a result of oversimplification or lack of context, but they can be very confusing and even scary.

For example, you’ve probably heard all of the following things about low-carb diets:

• That they are hard to stick to.

The Truth: Not so. A comparison of 19 randomized control trials that tested low-carb and low-fat diets found the average completion rate for low-carb diets was 79.51 percent compared to 77.72 percent for low-fat diets.

• They are dangerous because they are high in protein and fat, which increases cancer, diabetes, and heart disease risk.

The Truth: Not necessarily. Although there is evidence that a high processed meat intake increases cancer and mortality risk, this is not the same thing as a low-carb diet done properly.

And it’s true that low-carb diets should be high in fat and saturated fat, but neither are strong predictors of heart disease and if adequate plants are consumed, overall health is consistently improved.

• Your brain needs 130 grams of glucose a day to function properly and it must get that from carbs.

The Truth: Not quite. It’s true that the brain requires glucose to function but it can also run on ketones, which are a result of fat metabolism.

And, although zero carb diets are never a smart move, the body is able to manufacture glucose from other sources such as gluconeogenesis (protein being turned into carbs) or from lactate (produced during exercise).

That said, some people will do best with a higher carb intake, but the point is that the everyday things we hear about nutrition are rarely based on science or a complete understanding of the situation.

Fix It: Find a scientifically reputable source for your nutrition information and consider working with a dietitian who has experience helping active people and athletes make low-carb diets work.

Also, avoid polarizing foods into “good” and “bad.” Foods aren’t inherently “good” and “bad”, “healthy” or “unhealthy.” They’re just foods and it’s what happens to them when we eat them in different combinations that has healthy or unhealthy effects.

Mistake #9: Low Sodium or Potassium

When you shift to a low-carb diet, your body ends up excreting more sodium and water as it loses muscle glycogen (the storage form of carbs in the muscle). Potassium is also reduced by this process.

This can lead to mineral imbalances, lower blood pressure, and sluggishness. This situation is commonly mistaken as low blood sugar, and individuals often respond by increasing carb intake.

Fix It: No need to supplement, but make sure that if you exercise, you are consuming 2.5 to 3.5 grams of sodium a day in your diet. Potassium is easily consumed from green veggies and other plants. Cooking with meat broths can also help if you are sweating a lot during exercise.

If you are eating processed or packaged foods, chances are you are getting way more than enough sodium.

Anaerobic training, which includes lifting weights and higher intensity interval modes like sprinting, will improve the body’s ability to use fat for energy. Adapting your body to oxidize fat is something that needs to occur for a low-carb eating program to work.

It’s particularly important for overweight, sedentary people: Exercise is the catalyst to improve fat burning, whereas altering diet alone does not appear to be effective in the short term.

Exercise also triggers protein synthesis and preserves muscle mass during fat loss, which helps maintain the amount of calories the body burns at rest.

Caffeinated coffee in reasonable doses (1 to 3 cups) is a useful aid when transitioning to a low-carb diet because it can significantly enhance exercise performance and motivation when training with low carb energy stores.

Staying hydrated is extremely important because adequate water will help reduce carbohydrate cravings. You lose a significant amount of storage water as your body sheds its muscle glycogen stores. This is not a bad thing as long as you hydrate—something most people don’t do. In addition, water is necessary for beta-oxidation, which is how the body burns fat as an energy source.

Fix It: Start a strength training or moderate-intensity interval program.
Drink 1 to 3 cups of coffee (equal to 1-3 mg/kg of caffeine) pre-exercise.
Shoot for 0.6 to 0.7 ounces per pound of body weight of water a day.

References

Passmore, R., Swindells, Y. Observations on the respiratory quotients and weight gain of man after eating large quantities of carbohydrate. British Journal of Nutrition. 1963. 17, 331.